Provider Demographics
NPI:1902935463
Name:SHEVER, SEPIDEH (DPM)
Entity Type:Individual
Prefix:
First Name:SEPIDEH
Middle Name:
Last Name:SHEVER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4582 KINGWOOD DR
Mailing Address - Street 2:SUITE E#142
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345-2640
Mailing Address - Country:US
Mailing Address - Phone:281-862-9503
Mailing Address - Fax:281-862-9241
Practice Address - Street 1:15055 EAST FWY
Practice Address - Street 2:SUITE A20
Practice Address - City:CHANNELVIEW
Practice Address - State:TX
Practice Address - Zip Code:77530-4144
Practice Address - Country:US
Practice Address - Phone:281-862-9503
Practice Address - Fax:281-862-9241
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1743213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177385501Medicaid
TX189149101Medicaid
TX8J3211Medicare PIN
TX5541990001Medicare PIN
TX177385501Medicaid
TXDE1381Medicare PIN
TX5541990001Medicare NSC
TXV06202Medicare UPIN
TX00609ZMedicare PIN